Provider Demographics
NPI:1245788900
Name:GREGOREK, ADRIENNE ELISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ELISE
Last Name:GREGOREK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:ELISE
Other - Last Name:ODMARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:53 COLUMBUS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6909
Mailing Address - Country:US
Mailing Address - Phone:212-540-8450
Mailing Address - Fax:
Practice Address - Street 1:53 COLUMBUS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-540-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist